Aspirin-exacerbated respiratory disease (AERD)

Aspirin-exacerbated respiratory disease (AERD) – formerly known as Samter’s triad, aspirin triad, aspirin-sensitive asthma, and aspirin-intolerant asthma – is a chronic inflammatory disorder of the sinuses and lungs.

People with no prior conditions may suddenly experience a host of AERD symptoms, including:

• Asthma
• Chronic sinusitis
• Nasal polyps
• Nasal congestion
• Loss of sense of smell
• Intolerance to alcohol
• Respiratory reactions to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs), cause allergic reactions

Allergic symptoms to NSAIDs may include:

• Asthma attack
• Nasal congestion
• Runny nose
• Watery eyes
• Flushing of the head and neck
• Coughing
• Wheezing
• Shortness of breath
• Chest tightness

Less commonly, there can also be an accompanying itchy skin rash (hives) present or even stomach pain or nausea.

Since asthma is a prominent component of AERD and there are varying severities of asthma, AERD can be life-threatening when triggered by NSAIDs, respiratory infections, or other factors.

The exact causes of AERD and triggers associated with the condition aren’t fully understood, though research is ongoing.

AERD appears to be an inflammatory condition that results in an abnormal activation of mast cells, as well as specialized white blood cells called eosinophils, which infiltrate the sinuses and lungs.

This leads to an overproduction of, or sensitivity to, substances that cause inflammation.

These substances create a very complex web of interactions, and ultimately a very aggressive sinus and bronchial condition takes hold.

When a patient with AERD takes NSAIDs, a more dramatic surge in the release of inflammatory substances takes place. This is what causes the many symptoms we associate with AERD.

AERD is an acquired condition that is typically developed in adulthood. Patients may suddenly experience the symptoms listed above, with or without taking NSAIDs.

Approximately 10% of adults with asthma and 40% of patients with both asthma and nasal polyps have AERD, although they may not be readily diagnosed. Unfortunately, fragmentation of medical care and lack of AERD awareness by many physicians may result in a delay of AERD diagnosis.

With proper knowledge of AERD and the expertise of the specialists at Penn Medicine, diagnosing AERD in patients who present with asthma, nasal polyps, and a clear-cut history of respiratory reactions to NSAIDs, is often fairly straightforward.

In cases where the patient’s history is vague or the patient doesn’t take NSAIDs, a supervised oral, graded challenge may be necessary to clinch the diagnosis. The patient is provided a low dose of aspirin under close supervision by an AERD expert in a properly equipped facility. Then the dosage is safely and gradually increased over five to six hours until mild symptoms occur.

Patients with AERD will react with nasal, respiratory, or other allergic symptoms which are promptly and completely treated. Patients who do not react at all do not have AERD.

Once diagnosed, Penn Medicine AERD experts can begin effective treatment.

AERD has traditionally been difficult to treat and treatment has evolved significantly over the years.

Before 1980, the only known AERD treatment available was oral corticosteroids. However, long term use resulted in many serious side effects.

Many patients turned to surgery to get temporary relief, only to have their polyps quickly regrow unless they returned to oral corticosteroids.

In the early 1980’s researchers discovered that patients could be “desensitized to aspirin” whereby they would no longer react to NSAIDs as long as they continued to take aspirin after the desensitization procedure.

Soon after, they noted that AERD patients who had been desensitized were having better outcomes.

After many years of research, numerous studies have confirmed that a complete sinus surgery followed by aspirin desensitization is the most effective treatment for reducing the regrowth of new polyps and managing other AERD symptoms.